ABSTACT=Racial and ethnic minorities, persons of lower socioeconomic status, and the underinsured have especially low rates of cancer screening. This project will implement and test a simple, cost-effective office intervention to increase cancer screening rates among disadvantaged populations. The intervention strategy utilizes an office system approach designed to maximize cancer screening during routine primary care visits. The office intervention consists of a low-cost kit of materials and explicit responsibilities for patients and office staffs that will help providers perform opportunistic screening. Feedback of screening rates to providers is a second component of the intervention designed to maintain intervention effects. The intervention will be tested in a 4-year quasi-experimental trial involving 16 primary care clinics that serve predominately disadvantaged populations in Tampa, Florida and the surrounding county. We hypothesize that patients attending intervention clinics will be more likely to receive cancer screening services (Pap smears, mammograms, fecal occult blood testing) than those attending control sites. We will also explore the relative cost-effectiveness of the intervention strategy and the durability of intervention effects over time. This project takes advantage of clinical sites serving populations with demonstrated deficits in cancer screening. It also targets the most common reason patients give for not receiving cancer screening services (physicians didn't recommend it). Finally, the intervention utilizes resources that are available to most patients (primary care clinics and their personnel), and relies on low cost methods to promote screening. These factors greatly increase the likelihood that a successful intervention can diffuse into standard medical care.